AUTHOR=Umana Giuseppe Emmanuele , Scalia Gianluca , Graziano Francesca , Maugeri Rosario , Alberio Nicola , Barone Fabio , Crea Antonio , Fagone Saverio , Giammalva Giuseppe Roberto , Brunasso Lara , Costanzo Roberta , Paolini Federica , Gerardi Rosa Maria , Tumbiolo Silvana , Cicero Salvatore , Federico Nicoletti Giovanni , Iacopino Domenico Gerardo 

TITLE=Navigated Transcranial Magnetic Stimulation Motor Mapping Usefulness in the Surgical Management of Patients Affected by Brain Tumors in Eloquent Areas: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.644198

DOI=10.3389/fneur.2021.644198

ISSN=1664-2295

ABSTRACT=Background
The surgical strategy for brain glioma has been changed, shifting from tumor debunking to a more careful tumor dissection with the aim of a gross-total resection, extended beyond the contrast-enhancement MRI, including the hyperintensity on FLAIR MR images and defined as supratotal resection. It is possible to pursue this goal thanks to the refinement of several technological tools for the pre- and intraoperative planning likewise intraoperative neurophysiological monitoring (IONM), cortico-subcortical mapping, functional MRI (fMRI) and navigated transcranial magnetic stimulation (nTMS), intraoperative CT or MRI (iCT, iMR) and intraoperative contrast-enhanced ultrasound. This systematic review provides an overview of the state of the art in the application of nTMS and nTMS-based DTI-FT during brain tumor surgery.

Materials and Methods 
A systematic literature review was performed according to the PRISMA statement. The authors searched on PubMed and Scopus databases until July 2020 for published articles with the following Mesh terms: (Brain surgery OR surgery OR craniotomy) AND (brain mapping OR functional planning) AND (TMS OR transcranial magnetic stimulation OR rTMS OR repetitive transcranial stimulation). We included only studies regarding motor mapping in craniotomy for brain tumors, which reported data about CTS sparing.

Results 
A total of 335 published studies were identified through PubMed and Scopus databases. After a detailed examination of these studies, 325 were excluded from our review because of lack of data object of this search. TMS reported accuracy range is 0.4-14.8 mm between the APB hotspot (n1\4 8) in nTMS and DES from the DES spot; nTMS influenced the surgical indications in 34.3 - 68.5%.

Conclusion 
We found that nTMS can be defined safe and non-invasive technique and inn association to DES, fMRI, and IOM, improves brain mapping, extent of resection favoring a better postoperative outcome.